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Death education country signpost: India
History of death education
In India, a Hindu country with an elaborate death culture and rituals, death remains relatively taboo. The Western death education pioneers Elisabeth Kubler-Ross, Herman Feifel, Hannelore Wass and Cicely Saunders have been influential in scholarly circles, but Indian society mostly lacks a well developed teaching infrastructure.
Schools and colleges
There is a dearth of thanatology courses at school level, and measures to grow pupils’ understanding of grief and bereavement are scanty, reflecting the general unwillingness to talk about death in Indian society.
This 2019 study investigated what preschool children understand about death while this paper puts the case for introducing thanatology into the Indian education system. At the school level, the author suggests such a measure will help children understand what death is, how to deal with grief and loss and how to cope with the fear of death. Schools and colleges in India have been affected by a high rate of suicides, and it is thought that death education might ameliorate this problem.
Higher education
Researchers have identified a need to develop a curriculum that brings together indigenous knowledge and modern theory and clinical practice.
The Ageing, Lifecourse and Death Studies course at the National Law School of India University takes a socio-anthropological perspective and investigates trends in South Asia.
This 2018 study looked at the experience of death education among university students of social services and psychology, while another study from 2023 compared the confidence of students of death education in India and Italy. Findings showed that the students believed that death education can foster a positive attitude in society and improve the quality of death amongst dying people.
Medical and nursing programmes
There are more medical colleges and teaching hospitals in India than anywhere else — 579 to be precise. But serious doubts have been raised about the quality and ethics of the country's vast medical schooling system. A study revealed that more than half of those 579 didn't produce a single peer-reviewed research paper in over a decade (2005-2014), and that almost half of all papers were attributed to just 25 of those institutions.
A 2010 study explored palliative care awareness among Indian undergraduate healthcare students. The results showed students to be unprepared and uncertain in their approach of delivering end-of-life care.
Palliative care training is conspicuously absent in Indian nursing curricula. The End of Life Care Nursing Education Consortium (ELNEC) aims to redress the balance and improve nursing staff knowledge and attitudes. A 2022 study looked at the body’s impact on attitudes towards care of the dying.
Another study assessed ELNEC’s long-term impact on the knowledge and practice of Indian nurses working in non-palliative care settings.
Hospices and palliative care
Palliative care in India is mostly available in urban areas and at tertiary healthcare facilities. Only 1-2% of the estimated 7–10 million people who require palliative care have access to it despite the ever-increasing need for it in India, with its huge population and rising burden of chronic illness.
Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score (67th out of 80 countries). However there has been steady progress in the past few years through community-owned palliative care services. This review looked at hospice care in India in 2022.
A 2008 study into hospice and palliative care development in India mapped the existence of services state by state, and documented the perspectives and experiences of those involved. In 2010 a study looked at palliative care awareness among Indian undergraduate health care students at Manipal University. A 2015 paper explored palliative care in India and the scope for the future. Meanwhile a paper in 2016 focused on the inclusion of palliative care in Indian undergraduate physiotherapy courses.
In 2022 the increasing need for palliative care in India was noted in a narrative review while a 2020 study looked at whether online palliative care education can bridge this lack of provision.
Research in 2022 investigated the confidence of students in India and Italy after a course in death education and palliative psychology. In the same year, Life before Death in India: A Narrative Review touched upon the success of community-led projects involving volunteers in Kerala.
Studies
This paper explains Hindu practices related to death, and popular belief systems while this study examines the core issues of developing end of life care in India.
An article in the Indian Journal of Palliative Care covers the history of death education and influential early Western pioneers.
A PhD student penned Knowing Death: A cross cultural comparison into death practices between Delhi and London.
Institutions
The Indian Association of Palliative Care was founded in 1994.
Last Rites Services is a website run by the thanatologist Dr Raja Gopal Reddy Kolagani, who is recognised by the Association for Death Education and Counselling.
Books